Virtual Reality in residential aged care

Design: This feasibility study will run VR experiences as a small group session (n=5 per group) over four weeks, with residents receiving 2x sessions per week (total of 8 sessions). The VR sessions will be implemented at a large RAC home with four separate communities using convenience sampling. Three of the four communities will be used as intervention sites (total N=30) and one community as a control site (N=20). Residents will be excluded based on poor health status, severe vision impairment, and severely impaired verbal capabilities. Intervention: The VR intervention will take place in an area with minimal competing stimulation (sound, traffic, activity, and other residents). The intervention will be conducted in the dining room or activity room in groups of five. Trained clinical facilitators will guide and oversee VR sessions at the intervention site. They will be onsite three times per week to administer the VR intervention to consenting participants. All sessions will be video and audio recorded. Control group: The control group will participate in a small facilitated group activity (n=5 per group), with the VR experience supplemented for a group discussion on unrelated printed images. Sessions will mirror the VR intervention group, with sessions conducted twice per week for four weeks. Session length: 30 minutes (10 minutes pre-intervention observation, 5 minutes VR/control experience, 10 minutes post intervention observation, and 5 minutes debriefing, assessment, documentation). Technology : Samsung Galaxy S7 with VR headset. Videos will be selected from applications: Arscape, Nomads, Expeditions and Relax VR, under the guidance of an occupational therapist and registered nurses at the participating site. Scenes will be selected without fast movement or rapid changes in perspective. Consent: Written consent will be obtained from participants that are determined to have a psychogeriatric assessment scale (PAS) of four or under (indicating no or minimal cognitive impairment). For residents with a PAS above four, substituted written consent will be obtained from their legal guardians. Assent before each VR session will be obtained from each resident Ethics : Human Research Ethics approval has been given by UnitingCare Queensland Human Research Ethics Committee, approval no. Brimelow 21417, and The University of Queensland Human Research Ethics Committee, approval no. 2018000746 Outcomes: This study will provide the first evidence to date of the feasibility of immersive VR in RAC as a group activity to provide pleasure, stimulus, and to improve mental health. This trial will help to determine for which residents VR is most beneficial and appropriate, with intentions for the participating site to adopt the technology into its leisure and lifestyle program based on the findings. Evaluative measures Neuropsychiatric symptoms: Cornell Scale for Depression in dementia (CSD) – an assessment for depressive symptoms conducted by an observer in collaboration with the resident/carer. It contains 19 items scored on a three point scale; absent, mild/intermittent or severe, relating to symptoms experienced over the preceding week.- completed baseline (week 1) and post (week 6) Cohen Mansfield Agitation Inventory (CMAI) Short (Cohen-Mansfield, 1997) – a 29 item observer rated questionnaire that measures physical and verbal aggressive and non-aggressive behaviours observed in the previous two weeks. Completed baseline (week 1), mid intervention (week 3) and post (week 6) Geriatric Anxiety Index (GAI) (Pachana et al., 2007) – a 20 item self report questionnaire, rated as either agree or disagree that measures resident’s anxiety over the preceding week. Completed baseline (week 1), mid intervention (week 3) and post (week 6). Emotional response: Observed Emotions Rating Scale (OERS) (Van Haitsma and Klapper, 1999) - to measure resident’s emotional response the tool quantifies five observed emotions over a 10 minute period; pleasure, anger, anxiety/fear, sadness and general alertness (1 = never; 2 = <16 seconds; 3 = 16–59 seconds; 4 = 1–5 min; 5 = >5 min; and 7 = not in view). Completed before and after every VR /control session. The Person–Environment Apathy Rating (PEAR) apathy subscale (Jao et al., 2016) – measures apathy by observing six indicators; facial expressions, eye contact, physical engagement, purposeful activity, verbal tone, and verbal expression, on a 1–4 scale. Completed before and after every VR /control session. Smileometer (Read et al., 2002) – a self-reported scale of mood at that moment in time using. It is based on a 5-point Likert scale and uses five faces representing different levels of emotion from awful to brilliant. Completed before and after every VR /control session. Engagement: Resident feedback questionnaire. Completed after every VR /control session. Social interactions during group sessions (video recorded) Psychotropic medications: Review of psychotropic medication use over the previous month (pre and post). Completed at baseline (week 1) and post (week 6).